I don't have kids myself, so I can't talk from a mom perspective. But as a pediatrician with several months of neonatal intensive care experience, I'll throw myself into the deluge of information.
I could probably just agree with Sheila and be done with.
We standardly date babies by weeks (months are kind of hard to interpret for us wacky medical people). A normal pregnancy is 40 weeks, but once you reach 37 weeks we give you a gold star and call you term anyway. Anything less than that is considered premature. So, preemie babies range from 24 weekers to 36 weekers and vary HUGELY depending on where they fall in that range. * you may hear things about the occasional baby that they save at less than 24 weeks, but exceedingly uncommon - we don't even usually go to deliveries that are less than 24 weeks because there's pretty much NO chance for the baby.
At 34-35 weeks, they usually will not stop the labor, before that they would give moms medications to help stop the contractions - doesn't always work and sometimes we make the babies angry and they develop problems that lead to emergent C-sections. Most preemie babies, they will try to give mom doses of steroids 24-48 hours before the babies come to help the babies lung become more mature.
So, main problems with preemie babies...
Lungs!!!! The lungs don't usually mature until about 34 weeks gestation - there are varying levels of how bad the lungs are prior to that. We try to get them steroids before they come out. Once they're out, they may be intubated to help them breathe - depends on how poorly they're doing on their own. Where I am, we try to avoid intubating if we can because of airway problems later on if they do get intubated. So we'll use CPAP or high-flow air into their nose, with or without oxygen (as little as we can use - for other reasons). Usually takes the tiny babies a while to successfully breathe on their own without us giving any help - and some do still go home on oxygen. We will also sometimes intubate them, give them Surfactant (medicine to help keep the lungs from collapsing) and then try to get them extubated.
Feeding/gut problems- These babies are BAD at eating on their own and usually get fed with an NG tube into the stomach for a while until they are big enough and learn to suck on bottles or breastfeed. They are also at a higher risk for a bad baby problem with the intestines called NEC (necrotizing enterocolitis), which has scared the crap out of me several times in the past.
They also tend to have trouble keeping their blood sugars up after delivery - they don't have much in the way of fat stores, so we usually have to give them IV fluids with sugar in it.
Neuro- They're at higher risk for bleeds into their brain (intraventricular hemorrhages) - the earlier you are, the more likely the bleed (and the worse it's likely to be). These bleeds can lead to developmental problems (cerebral palsy among other things) later on and also problems with seizures. Their nervous system is also not mature - preemie tend to have trouble controlling their heart rate - so they drop down low in response to stress or really just about anything. They also forget to breathe...we give them caffeine to help remind them to do that! These apnea/bradycardia spells (As and Bs) can continue to happen until the babies reach corrected ages of 35-36 week gestations.
Temperature- They have trouble keeping their temperatures up, will usually need to be under warmers for a while (or incubators if they're really early).
Jaundice- Preemies are at higher risk for jaundice than term babies. All babies have some trouble breaking down and getting rid of dead red blood cells initially - their livers aren't quite up to the task yet. But preemies baby have more trouble, so tend to end up under bili lights for a few days.
Infection- Huge, big, scary problem for preemies. They are a much higher risk in the newborn period to get serious infections - bacteria in the blood, urine, spinal fluid, etc.... A lot of times, we just automatically start them on antibiotics for 48 hour rule-outs. We have to worry about whether mom was infected and if that's why they came early. Their immune systems suck! And when they get sick, they don't have a lot of reserve. The preemie babies (especially with lung problems) are also at higher risk for RSV and other viral infections of the lungs over the 1st winter or 2 of life. We will give them monthly shots of Synagis to protect from RSV, but there's lots of other viruses we can't protect against.
Plenty of other problems that happen to babies before, during and after labor...and yet amazingly most of them make it through unscathed. I'm always amazed.
I'm also happy to help with any particular questions you might have. I love these boards - so many crazy people willing to share their expertise!
Jill
